Referral Specialist processes insurance pre-verification for hospital admissions or specialty service office visits. Gathers pertinent information from patients, insurance carriers, financial counselors, and other staff to confirm the patient's financial obligations for services. Being a Referral Specialist acts as a liaison between hospitals, clinical staff, health plans, providers, and patients to process referrals. Verifies insurance coverage and obtains required authorizations when necessary. Additionally, Referral Specialist documents referrals, communications, actions, and other data in an information management system. Generates and distributes all applicable forms, notifications, and paperwork. Requires a high school diploma. Typically reports to a supervisor. The Referral Specialist works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Referral Specialist typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
Description
United Family Medicine (UFM) is a Federally Qualified Health Center in St. Paul, where patients receive community-based Family Practice medical care in addition to mental health, dentistry, social work and other integrated services. When joining UFM, you become part of a diverse, inclusive, and welcoming team who are dedicated to serving our patients and pursuing our mission to deliver excellent healthcare for all and training for the providers of tomorrow.
JOB SUMMARY:
The Referral Specialist is responsible for obtaining authorizations or referrals for visits, testing, surgeries, and other healthcare services. This position also includes but is not limited to monitoring outcomes to ensure establishing and maintaining effective procedures for managed care referrals. The Referral Specialist will assist all departments: dental, medical, behavioral health, diabetic education/dietician, and podiatry. The Referral Specialist will ensure that all referrals are closed using the Closed Loop Method.
ESSENTIAL FUNCTIONS:
Perform other tasks as assigned.
Requirements
KNOWLEDGE, SKILLS, AND ABILITIES:
EDUCATION/EXPERIENCE:
CERTIFICATES, LICENSES, REGISTRATIONS:
N/A
PHYSICAL DEMANDS:
WORK ENVIRONMENT:
Work is performed in a clinic office environment. Contact with staff, patients and outside agencies. Possible exposure to communicable disease and medical preparations common to clinic environment.
SUPERVISORY RESPONSIBILITIES:
None
Beginning January 4, 2022, all job offers are conditioned on the candidate being fully vaccinated against COVID-19 with a vaccine authorized for emergency use or FDA-approved. A person is only considered “fully vaccinated” two weeks after receiving a single J&J vaccine or a second Pfizer or Moderna vaccine shot.
In addition, job offers made during flu season are conditioned on the candidate receiving the annual flu vaccination before their start date.
UFM is an equal opportunity employer.